The goal of this research is to assess the number and geographic distribution of mammography resources in the US, and to evaluate the relationship between the distribution of these resources and the use and outcomes of mammography for breast cancer screening and post-treatment surveillance. Screening mammography has been shown to reduce breast cancer mortality, and current national guidelines recommend annual or biennial screening mammography for women age 40 and older. Despite increases in mammography rates, about 25% of US women age 40 and older report having no recent screening mammogram, and this proportion varies widely from state to state. Annual mammography is also recommended for post-treatment breast cancer surveillance, but many patients do not adhere with this guideline. A variety of individual, provider, and health care market characteristics are associated with mammography utilization, but few studies have examined the role of mammography resources. In the proposed study, measures of mammography capacity and accessibility will be estimated based on analysis of mammography facility data. Geographic information systems and spatial-analytic techniques will be used to map the location of mammography resources in relation to the adult female population. Multivariate statistical methods will be used to assess the correlation of mammography capacity and accessibility with utilization and outcomes. Mammography utilization information will come from national survey data, Medicare claims, and Medicare claims linked with population-based cancer registry data. Information on breast cancer stage and tumor size will come from cancer registry data. This research will identify areas and predictors of undersupply, oversupply, and maldistribution of the technological infrastructure and health care work force required for the delivery of mammography, and suggest strategies for modifying the distribution of resources in order to reduce disparities in mammography utilization rates and breast cancer outcomes. In conjunction with this research, training activities and mentoring will facilitate the applicant's pursuit of a research career in breast cancer prevention, screening, treatment and outcomes, with a specific focus on geographic disparities in the supply and utilization of health care resources.